Provider Demographics
NPI:1679704902
Name:WITTE FUDGE, ERIN MICHELLE
Entity Type:Individual
Prefix:
First Name:ERIN
Middle Name:MICHELLE
Last Name:WITTE FUDGE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ERIN
Other - Middle Name:MICHELLE
Other - Last Name:WITTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1025 N AUSTIN ST
Mailing Address - Street 2:
Mailing Address - City:SEGUIN
Mailing Address - State:TX
Mailing Address - Zip Code:78155-4517
Mailing Address - Country:US
Mailing Address - Phone:830-379-1184
Mailing Address - Fax:830-303-2314
Practice Address - Street 1:1025 N AUSTIN ST
Practice Address - Street 2:
Practice Address - City:SEGUIN
Practice Address - State:TX
Practice Address - Zip Code:78155-4517
Practice Address - Country:US
Practice Address - Phone:830-379-1184
Practice Address - Fax:830-303-2314
Is Sole Proprietor?:No
Enumeration Date:2009-08-04
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX713448363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily